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CAH281355-02 OGALLALA COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
OGALLALA COMMUNITY HOSPITAL
Subdivision Name
Clinic - Pain-Mgmt-Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH281355-02
Medicare Provider Number
281355
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/19/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Ogallala Community Hospital
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263
Primary Contact
Banner Health Ogallala Community Hospital
Vickie L. Meier, Associate Director of Pharmacy
(308) 284-7223
Addresses
Street Address
2601 North Spruce Street
Suite A
Ogallala, NE 69153
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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